[Stability of osteosyntheses for condylar head fractures in the clinic and biomechanical simulation]. / Stabilität der Osteosynthese bei Gelenkwalzenfrakturen in Klinik und biomechanischer Simulation.

BACKGROUND: Fractures of the condylar head are traditionally managed by closed techniques, despite a considerable rate of dysfunctional problems. PDS pin osteosynthesis (presented by Rasse 1992) via a preauricular approach failed to become established as a standard procedure due to a lack of stability. Alternatively, mini- or microplating, as performed in our patients (101 condylar head fractures between 1993 and 2000), showed high-grade limitations of translatory movements in about 30% due to scarification after loosening of osteosynthesis materials. The aim of this study was to establish an efficient procedure for achieving a functionally stable and atraumatic osteosynthesis. METHODS: For the definition of a suitable procedure, models of the mandible (standardized fractures, types A, B, and C) were osteosynthesized (six samples for each type of fracture and type of screw), each with three PDS pins, 2.0 mm resorbable, 2.0 cortical, 1.7 and 1.2 mm small fragment screws, and exposed to increasing loads in centric (0-20-35 mm opening) and eccentric (35 mm opening) condylar positions. A computerized biomechanical test stand allowed a dynamic simulation of chewing forces (16 hydraulic drives). The resulting fracture gaps were measured without contact by a motion capture system. RESULTS: Within physiological limits, only 1.7 small fragment and 2.0 mm cortical screws were able to bear occlusal loadings up to 200 N (1.2 mm small fragment screws up to 150 N, resorbable 2.0 mm screws up to 100 N, and PDS-pins up to 50 N). In a pullout experiment (condylar spongious bone of young pigs, aged 4-6 months), 1.7 mm small fragment screws showed superior retention. A consecutively developed small fragment screw-system has been applied clinically in 74 condylar head fractures (58 patients). After removal of osteosynthesis material, 41 of 49 TM joints have so far shown complete restitution. CONCLUSIONS: The newly developed osteosynthesis system using a retroauricular approach based on 1.7 mm small fragment screws makes maxillomandibular immobilization unnecessary. The extra-articular position of the screw heads prevents scar-induced articular limitations. Preexisting degenerative alterations of the TMJ soft tissues, however, will affect functional results adversely.

[Clinical experience with percutaneus large-core needle biopsies of the breast and evaluation of cytopathological and histopathological results]. / Klinische Erfahrungen mit einer kombinierten imprintzytologischen und histopathologischen und Begutachtung von perkutanen Stanzbiopsien der Mamma.

OBJECTIVE: Core needle biopsy (CNB) allows a microinvasive diagnosis of breast lesions. We investigated whether imprint cytology of CNB specimens is a useful method of rapidly obtaining additional diagnostic information. MATERIAL AND METHOD: During five years 46 218 breast examinations for 23 300 patients were performed. 563 patients were examined by CNB. The results of imprint cytology were compared with the histopathological results. Statistical analysis was done for all patients who underwent subsequent surgery. RESULTS: 195 of 563 patients were treated surgically. 155 patients exhibited malign lesions. 40 patients showed benign breast lesions. Four patients with malign findings in imprint cytology and histopathology of CNB were treated conservatively. Imprint cytology had a sensitivity of 0.89, specificity of 0.88, positive predictive value of 0.96 and negative predictive value of 0.67. Histopathology revealed a sensitivity of 0.90, specificity of 0.95, positive predictive value of 0.98 and negative predictive value of 0.70. 364 patients with benign findings in imprint cytology and histopathology were controlled subsequently. One of these patients developed five month later an invasive ductal tumor. CONCLUSION: Imprint cytology of CNB is a reliable method to obtain additional diagnostic information. Inadequate and suspicious cases should be evaluated based on complementary diagnostic procedures for breast lesions.

Retropatellar forces after rupture of the PCL and patello-tibial transfixation: an in vitro study.

Compared to injuries of the other knee ligaments, a rupture of the posterior cruciate ligament (PCL) is relatively rare. Treatment may be conservative or operative. A rupture that has been operated on temporarily can be stabilised using a Grammont patello-tibial transfixation (olecranisation). Flexion and extension between 30 degrees and 60 degrees are allowed. The advantage of this method is that it avoids complete immobilisation of the joint and also the reduction of pull on the PCL. However, patients treated with this method show long-term osteoarthritis of the retropatellar joint area. Our study aimed to show the distribution of forces at the dorsal patellar surface in the following: (1) knee with intact ligaments; (2) knee with PCL rupture; (3) knee with PCL rupture plus olecranisation. Fourteen fresh knee specimens were investigated in a Plitz/Wirth knee kinemator. The femur was fixed while the tibia was flexed between 5 degrees and 120 degrees. Pull was placed on the patella and on the dorsal side of the tibia with weights over the tendons of the quadriceps and the roots of the ischio-crural muscles. With the aid of a special measurement device in the patella, the medially laterally, proximally and distally acting forces in a movement cycle could be measured as well as the total retropatellar force in the above experimental setups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of palpation findings in breast examination]. / Zur Wertigkeit des Tastbefundes bei der Brustuntersuchung.

During a period of 3.5 years 13,214 patients were examined in a specialised breast clinic; 87% of the women had been referred by gynaecologists. 73% of the 160 carcinomas discovered 65% of the 143 fibroadenomas and 32% of the 982 cysts were palpable. Among 2,355 patients with a positive palpation, a carcinoma was found only in 5% of cases, whilst a carcinoma was found in 0.4% of the 10,819 patients with negative palpation. Therefore the use of apparatus in breast diagnosis is highly recommended both to avoid unnecessary surgery and to discover small cancers.

[Granular cell myoblastoma of the mammary gland and its differentiation from mammary carcinoma (author's transl)]. / Das Granularcellmyoblastom der weiblichen Brust und seine differentialdiagnostische Abgrenzung gegen das Mammacarcinom.

Report of a case with granular cell tumor of the mammary gland. These tumors are observed infrequently and are important because of the difficulty to differentiate those lesions from carcinoma of the breast. The accurate diagnosis is possible by cytology and microscopy.

[The atypical vessels of the feminine breast in the plate-thermography (author's transl)]. / Die atypischen Gefässe der weiblichen Brust bei der Plattenthermographie

In 215 atypical--including 109 carcinomas and 8 carcinomata in situ--as well as 294 verified benign histological evidences of the breast the value of the main clinical, mammographical and plate-thermographical symptoms is examined. The clinical palpable tumors, the mammographical irregular connective tissue and/or the homogenous opacity, as well as plate-thermographical atypical vessels proved to be a relatively insecure sign of a carcinoma. The individual characteristics of the atypical vessels in the plate-thermography according to Tricoire were worked out. The sudden and blunt breaking-off of a atypical vessel has to be considered the most suspicious sign for a carcinoma. The plate-thermography according to Tricoire is also usable as additive method for diagnosis of benign breast-tumors that don't have to be exstirpated.

[Morphological study on 167 Wertheim-operation specimens (author's transl)]. / Morphologische Studie an 167 Wertheim-Operationspräparaten

The squamous cell carcinoma of the uterine cervix was examined in 167 cases with the regard to the spreading and the dependence of metastazation on the size of the primary tumor. Up to a primary tumor size of 5 + 10 + 10 mm a metastazation of 1,58% in the lymph nodes, of 30,9% at stage Ib and of 57,6% at stage II was found. The metastazation rate from one stage to the other seems not to be continuously but skippy. The hysterectomy seems to be an entirely sufficient therapy in case of a microcarcinoma, provided that accurate three-dimensional measurement proves that the size does not exceed 5 + 10 + 10 mm. The Wertheim's operation should give its best results at stage Ib, as long as it includes the careful removal of the pelvic lymph nodes.